Background:
Metastatic disease from a non-small cell lung cancer to the adrenal gland is common, and systemic treatment is the most frequent therapeutic option. Nevertheless, in patients suffering from an isolated adrenal metastasis, a survival benefit could be achieved after surgical resection. Stereotactic body radiation treatment (SBRT) increase local tumor control and could be an alternative option. We present our initial institutional experiences with SBRT for adrenal gland metastases.
Patients and Methods:
Between July 2002 and September 2009, 18 patients with a non-small cell lung cancer and adrenal metastasis received SBRT. An isolated adrenal metastasis was diagnosed in 13 patients, while 5 patients with multiple metastatic lesions had SBRT due to back pain. Depending on treatment intent and target size, the dose/fraction concept varied from 5 x 4 Gy to 5 x 8 Gy. Dose was given with an isotropic convergent beam technique to a median maximum dose of 132% to the target’s central part.
Results:
The mean clinical (CTV) and planning target volume (PTV) was 89 cm³ (5–260 cm³) and 176 cm³ (20–422 cm³). A median progression-free survival time (PFS) of 4.2 months was obtained for the entire patient group, with a markedly increased PFS of 12 months in 13 patients suffering from an isolated metastasis of the adrenal gland. After a median follow-up of 21 months, 10 of 13 patients (77%) with isolated adrenal metastasis achieved local control. In these patients, median overall survival (OS) was 23 months.
Conclusion:
SBRT is a feasible and safe technique for lung cancer patients with adrenal gland metastasis. In patients with an isolated adrenal metastasis median OS of 23 months was excellent and comparable to data after surgical removal, but noninvasive. Acute side effects were mild.
Hintergrund:
Nebennierenmetastasen nichtkleinzelliger Bronchialkarzinome sind häufig, und die systemische Therapie ist die meistgenutzte Behandlungsoption. Im Fall von Patienten mit isolierter Nebennierenmetastase verzeichnen chirurgische Daten einen Überlebensgewinn nach einer Resektion. Die extrakranielle stereotaktische Radiotherapie (ESRT) bietet aufgrund der sehr guten lokalen Kontrolle eine nichtinvasive Alternative. Wir präsentieren unsere institutionellen Erfahrungen mit der ESRT von Nebennierenmetastasen.
Patienten und Methodik:
Zwischen Juli 2002 und September 2009 wurden 18 Patienten mit Nebennierenmetastasen bei nichtkleinzelligen Bronchialkarzinomen mit ESRT behandelt (Tabelle 1). Eine isolierte Nebennierenmetastase wurde in 13 Fällen diagnostiziert, 5 Patienten wurden aufgrund von Flankenschmerzen bei multipel metastasiertem Tumorleiden behandelt. Abhängig von der Behandlungsintention und dem Bestrahlungsvolumen variierte das Dosierungs-/Fraktionierungskonzept zwischen 5 x 4 Gy bis 5 x 8 Gy. Die Dosis wurde appliziert über eine isozentrische conformale Mehrfeldertechnik mit einem medianen Dosismaximum von 132% im Tumorzentrum.
Ergebnisse:
Das mittlere klinischen Zielvolumen (CTV) und das mittlere Planungszielvolumen (PTV) lag bei 89 cm³ (5–260 cm³) bzw. 176 cm³ (20–422 cm³) (Tabelle 2). Die mediane progressionsfreie Zeit (PFS) von allem Patienten lag bei 4,2 Monaten bei deutlich längerer PFS von 12 Monaten für die 13 Patienten mit isolierter Nebennierenmetastase (Abb. 2). Nach einer medianen Nachbeobachtung von 21 Monaten waren 10 (77%) dieser 13 Patienten lokal kontrolliert mit einem medianen Überleben von 23 Monaten (Abb. 3).
Schlussfolgerung:
ESRT ist eine praktikable und sichere Technik zur Behandlung von Patienten mit Nebennierenmetastasen nichtkleinzelliger Bronchialkarzinome. Das mediane Überleben von 23 Monaten der Patienten mit isolierter Nebennierenmetas-tase ist exzellent und vergleichbar mit chirurgischen Daten, dabei mit dem Vorteil der nicht invasiven Behandlungsmethode und geringer Nebenwirkungsrate.
Similar content being viewed by others
References
Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer 1950;3:74–85.
Blomgren H, Lax I, Naslund I et al. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol 1995;34:861–70.
Chang BK, Timmerman RD. Stereotactic body radiation therapy: a comprehensive review. Am J Clin Oncol 2007;30:637–44.
Chawla S, Chen Y, Katz AW et al. Stereotactic body radiotherapy for treatment of adrenal metastases. Int J Radiat Oncol Biol Phys 2009;75:71–5.
de Perrot M, Licker M, Robert JH et al. Long-term survival after surgical resections of bronchogenic carcinoma and adrenal metastasis. Ann Thorac Surg 1999;68:1084–5.
Duh QY. Resecting isolated adrenal metastasis: why and how? Ann Surg Oncol 2003;10:1138–9.
Heniford BT, Arca MJ, Walsh RM et al. Laparoscopic adrenalectomy for cancer. Semin Surg Oncol 1999;16:293–306.
Herfarth KK, Debus J, Lohr F, B et al. Extracranial stereotactic radiation therapy: set-up accuracy of patients treated for liver metastases. Int J Radiat Oncol Biol Phys 2000;46:329–35.
Herfarth KK, Debus J, Wannenmacher M. Stereotactic radiation therapy of liver metastases: update of the initial phase-I/II trial. Front Radiat Ther Oncol 2004;38:100–5.
Katoh N, Onimaru R, Sakuhara Y et al. Real-time tumor-tracking radiotherapy for adrenal tumors. Radiother Oncol 2008;7:418–24.
Kebebew E, Siperstein AE, Clark OH et al. Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg 2002;137:948–51.
Kim SH, Brennan MF, Russo P et al. The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer 1998;82:389–94.
Lax I, Blomgren H, Naslund I et al. Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. Acta Oncol 1994;33:677–83.
Lo CY, van Heerden JA, Soreide JA et al. Adrenalectomy for metastatic disease to the adrenal glands. Br J Surg 1996;83:528–31.
Lucchi M, Dini P, Ambrogi MC et al. Metachronous adrenal masses in resected non-small cell lung cancer patients: therapeutic implications of laparoscopic adrenalectomy. Eur J Cardiothorac Surg 2005;27:753–6.
Luketich JD, Burt ME. Does resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg 1996;62:1614–6.
Mercier O, Fadel E, de Perrot M et al. Surgical treatment of solitary adrenal metastasis from non-small cell lung cancer. J Thorac Cardiovasc Surg 2005;130:136–40.
Oshiro Y, Aruga T, Tsuboi K et al. Stereotactic body radiotherapy for lung tumors at the pulmonary hilum. Strahlenther Onkol 2010;186:274–9.
Porte H, Siat J, Guibert B et al. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg 2001;71:981–5.
Raviv G, Klein E, Yellin A et al. Surgical treatment of solitary adrenal metastases from lung carcinoma. J Surg Oncol 1990;43:123–4.
Sarela AI, Murphy I, Coit DG et al. Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol 2003;10:1191–6.
Short S, Chaturvedi A, Leslie MD. Palliation of symptomatic adrenal gland metastases by radiotherapy. Clin Oncol (R Coll Radiol) 1996;8:387–9.
Sobin LH, Wittekind Che, Wiley. UICC: TNM Classification of malignant tumours. 6th edition (2002). New York, UICC 2002.
Soffen EM, Solin LJ, Rubenstein JH et al. Palliative radiotherapy for symptomatic adrenal metastases. Cancer 1990;65:1318–20.
Therasse P, Arbuck SG, Eisenhauer EA et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205–16.
Uematsu M, Sonderegger M, Shioda A et al. Daily positioning accuracy of frameless stereotactic radiation therapy with a fusion of computed tomographyand linear accelerator (focal) unit: evaluation of z-axis with a z-marker. Radiother Oncol 1999;50:337–9.
Wang C, Nakayama H, Sugahara S et al. Comparisons of dose-volume histograms for proton-beam versus 3-D conformal x-ray therapy in patients with stage I non-small cell lung cancer. Strahlenther Onkol 2009;185(4):231–4.
Wiehle R, Koth HJ, Nanko N et al. On the accuracy of isocenter verification with kV imaging in stereotactic radiosurgery. Strahlenther Onkol 2009; 185:325–30.
Wiezorek T, Schwahofer A, Schubert K. The influence of different IMRT techniques on the peripheral dose: a comparison between sMLM-IMRT and helical tomotherapy. Strahlenther Onkol 2009;185:696–702.
Wood BJ, Abraham J, Hvizda JL et al. Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases. Cancer 2003;97:554–60.
Wulf J, Hadinger U, Oppitz U et al. Stereotactic radiotherapy of extracranial targets: CT-simulation and accuracy of treatment in the stereotactic body frame. Radiother Oncol 2000;57:225–36.
Wulf J, Hadinger U, Oppitz U et al. Stereotactic radiotherapy of targets in the lung and liver. Strahlenther Onkol 2001;177:645–55.
Zeng ZC, Tang ZY, Fan J et al. Radiation therapy for adrenal gland metastases from hepatocellular carcinoma. Jpn J Clin Oncol 2005;35:61–7.
Zimmermann FB, Geinitz H, Schill S et al. Stereotactic hypofractionated radiation therapy for stage I non-small cell lung cancer. Lung Cancer 2005;48:107–14.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Holy, R., Piroth, M., Pinkawa, M. et al. Stereotactic Body Radiation Therapy (SBRT) for treatment of adrenal gland metastases from non-small cell lung cancer. Strahlenther Onkol 187, 245–251 (2011). https://doi.org/10.1007/s00066-011-2192-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00066-011-2192-z